原发性肝细胞癌病人手术安全性的临床研究

发布时间：2018-07-13 21:46

【摘要】：第一部分原发性肝细胞癌切除术后肝功能不全的危险因素分析目的分析原发性肝细胞癌切除术后发生肝功能不全的围手术期相关危险因素。方法回顾性分析2011年1月至2013年4月我院298例行手术切除的原发性肝细胞肝癌患者的临床资料,采用单因素和多因素分析术后肝功能不全的术前及术中危险因素。结果单因素分析显示谷草转氨酶(aspartate Transaminase, AST)、白蛋白(albumin, ALB)、碱性磷酸酶(alkaline Phosphatase, ALP)、总胆红素(total Bilirubin, TBIL),谷氨酰转移酶(gamma glutamyl transferase, GGT)、吲哚菁绿15分钟滞留率(indocyanine green retention rate at15minute, ICG-R15)、肿瘤大小、慢性肝功能不全(chronic liver dysfunction, CLD)评分、手术时间、肝门阻断时间、切除肝段数目及术中出血量是原发性肝细胞癌切除术后发生肝功能不全的重要因素(P0.05)；将上述危险因素进行多因素回归分析,结果显示影响术后肝功能不全程度的独立危险因素是术前ICG-R15及术中的肝门阻断时间、手术时间、切除肝段数目。(P0.05) 结论ICG-R15的高低、术中的肝门阻断时间和手术时间的长短和切除肝段数目是导致肝肿瘤根治性切除术后肝功能不全的主要因素。第二部分不同肝血流阻断方法在原发性肝细胞癌切除术中的效果比较目的评价三种不同入肝血流阻断方法在原发性肝细胞癌手术切除术中的临床效果。方法回顾性分析2011年1月至2013年3月期间我院218例原发性肝细胞癌手术患者的临床资料,根据术中血流阻断方法分为Pringle组(88例行Pringle法阻断入肝血流),半肝血流阻断组(51例行选择性的半肝血流阻断),联合组(79例行肝下下腔静脉阻断联合Pringle法阻断入肝血流。比较三组患者的手术时间、血流阻断时间、肝切除量、失血量、输血率及术后肝功能指标。结果三组患者的术前情况、手术时间、入肝血流阻断时间及肝切除量的差异均无统计学意义(P0.05)：联合组患者的术中出血量及输血率均明显低于Pringle组和半肝血流阻断组(382.29±166.18mL,25.31%:728.98±500.21mL,35.23%:432.84±127.13mL,29.41%;P0.05):三组患者术后第3天和第7天的转氨酶和总胆红素相比,半肝血流阻断、联合组明显低于Pringle组,差异有统计学意义(P0.05),而在白蛋白水平及术后并发症的发生率方面,各组间无统计学意义(P0.05)。结论原发性肝细胞癌切除术中采用肝下下腔静脉阻断联合Pringle法能够显著减少术中失血量和输血率,在不增加术后并发症发生率的基础上有利于术后肝功能恢复。
[Abstract]:Part I risk factors of liver dysfunction after resection of primary hepatocellular carcinoma objective to analyze the perioperative risk factors of hepatic insufficiency after resection of primary hepatocellular carcinoma (HCC). Methods the clinical data of 298 patients with primary hepatocellular carcinoma (HCC) surgically resected in our hospital from January 2011 to April 2013 were analyzed retrospectively. The risk factors of postoperative hepatic insufficiency were analyzed by univariate and multivariate analysis. Results univariate analysis showed that aspartate transaminase (AST), albumin (Alb), alkaline phosphatase (ALP), total bilirubin (TBIL), glutamyltransferase (gamma glutamyl transferase, GGT), indocyanine green retention rate (indocyanine green retention rate at 15minute, ICG-R15), tumor size, total bilirubin (TBIL), indocyanine green retention rate (indocyanine green retention rate at 15minute, ICG-R15), total bilirubin (TBIL), glutamyltransferase (gamma glutamyl transferase, GGT), indocyanine green retention rate (indocyanine green retention rate at 15minute, ICG-R15), tumor The scores of chronic hepatic insufficiency (chronic liver dysfunction,), the time of operation, the time of hepatic hilus occlusion, the number of hepatic segments resected and the amount of intraoperative bleeding were the important factors for the occurrence of hepatic insufficiency after primary hepatocellular carcinoma resection (P0.05). Multivariate regression analysis of the above risk factors showed that the independent risk factors affecting the degree of hepatic insufficiency after operation were preoperative ICG-R15, hepatic hilus occlusion time, operative time, and the number of hepatic segments resected. (P0.05) conclusion ICG-R15 is high and low. The duration and duration of hepatic hilus occlusion and the number of hepatic segments were the main factors leading to hepatic insufficiency after radical resection of liver tumor. Part two the effect of different hepatic blood flow occlusion methods in primary hepatocellular carcinoma objective to evaluate the clinical effect of three different hepatic blood flow occlusion methods in primary hepatocellular carcinoma surgery. Methods the clinical data of 218 patients with primary hepatocellular carcinoma in our hospital from January 2011 to March 2013 were retrospectively analyzed. According to the method of intraoperative blood flow occlusion, the patients were divided into three groups: Pringle group (88 cases), hemihepatic occlusion group (51 cases) and combined group (79 cases) with inferior vena cava occlusion combined with Pringle method. The operative time, blood flow occlusion time, hepatectomy volume, blood loss, blood transfusion rate and postoperative liver function were compared among the three groups. Results the preoperative condition and operation time of the three groups were analyzed. The blood loss and blood transfusion rate in the combined group were significantly lower than those in the Pringle group and the hemihepatic blood flow occlusion group (382.29 卤166.18mL, 25.31cm) (728.98 卤500.21mL, 35.23mL, 35.232.84 卤127.13mL, 29.41g / L, P 0.05): the third and seventh days after operation in the combined group were significantly lower than those in the Pringle group and the hemihepatic blood flow occlusion group (382.29 卤166.18mL, 25.31ml). Transaminase compared with total bilirubin, The hemihepatic blood flow occlusion in the combined group was significantly lower than that in the Pringle group, the difference was statistically significant (P0.05), but in the albumin level and the incidence of postoperative complications, there was no statistical significance among the groups (P0.05). Conclusion Intrahepatic inferior vena cava occlusion combined with Pringle method can significantly reduce the blood loss and blood transfusion rate in primary hepatocellular carcinoma resection. It is beneficial to the recovery of liver function without increasing the incidence of postoperative complications.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.7

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